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Obesity Incidence Higher in Rural Than Urban Population

Obesity Incidence Higher in Rural Than Urban Population

Written by Dr. Lakshmi Venkataraman, MD
Medically Reviewed by 
The Medindia Medical Review Team on May 9, 2019 at 6:05 PM
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  • Rates of obesity are rising faster in rural areas than in urban areas disproving long-held perceptions about city life being associated with an increased risk of obesity and other health issues
  • Cities offer better and more options for improving general health such as wider range of dietary options, better infrastructure for physical exercise and relaxation and access to better health care
  • The findings of the study suggest that fresh thinking and exploring newer ways to tackle the global health problem of obesity is the need of the hour

Obesity rates are rising faster in rural areas than urban areas disproving long-held perceptions about city life, reveals a recent study done by Imperial College, London, looking at global body mass index (BMI) trends. The findings of the study appear in Nature.

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Obesity Incidence Higher in Rural Than Urban Population

Readily available patient data such as height and weight are used to calculate body mass index BMI, an internationally employed scale to determine whether an individual has a healthy weight for their height. BMI categorizes a person as underweight, normal, overweight and obese based on the value.

Design of the Study

This UK study looked at the height and weight data of over 112 million adult men and women spread across rural and city areas in 200 countries between 1985 and 2017. The study involved a team of over 1000 scientists across the world and looked at the trends in both low and middle-income countries as well as high-income countries.

Key Findings of the Study

  • Between 1985 and 2017, BMI increased worldwide by an average of 2.2 kg/m2 in men and 2.0 kg/m2 in women equivalent to each a 5-6 kilo increase in weight
  • Average BMI increase in rural population was 2.1 kg/m2 in both women and men
  • Average increase in urban areas was 1.3 kg/m2 and 1.6 kg/m2 in women and men respectively
  • Interestingly, over 50% of the increase in BMI was from rural areas.
  • In some low- and middle-income nations, rural areas accounted for nearly 80% of this increase
  • In 1985 and before, adults living in cities of over 75% of the countries had a higher BMI than their rural counterparts. With time, this gap between city and rural population narrowed or even reversed.
"The results of this massive global study overturn commonly held perceptions that more people living in cities is the main cause of the global rise in obesity," explains senior author Professor Majid Ezzati of Imperial's School of Public Health. "This means that we need to rethink how we tackle this global health problem."

Reasons for Rising BMI Trends in Developing Nations & The Developed World

  • Rural areas in developing nations have seen a change towards higher income, improved infrastructure for health care as well as mechanized agriculture and more buying of personal transport, all of which improve quality of life, but also lead to lesser physical exercise, increased spending on unhealthy junk food. These factors may have contributed to the rising BMI in the rural population in low and middle-income countries.
  • In high-income countries, the reason for increasing BMI since 1985 could be attributed to the disadvantages experienced by those living in rural areas including fewer dietary and healthy food options, lower income and education, and fewer options of sports and recreational facilities.
  • The major exception to the worldwide BMI trend was sub-Saharan Africa where urban women gained weight faster possibly due to a more sedentary lifestyle such as desk jobs, access to unhealthy foods, motorized travel compared to rural women who still need to walk a lot and expend more energy to obtain domestic necessities such as firewood and fetching water.

Country Wise & Regional Data on BMI Globally between 1985-2017

  • BMI decreased slightly during the study period among women in twelve countries, including Europe (France, Italy, Malta, Portugal, Czech Republic, Greece, Spain, Lithuania, and Serbia) and the Asia Pacific (Japan, Nauru, Singapore).
  • BMI increased by more than 5 kg/m2 in Egyptian and Honduran women.
  • BMI increased in men in all countries, the biggest increases were seen in Saint Lucia, Bahrain, China, Peru, China, USA and the Dominican Republic, all by over 3.1 kg/m2.
  • Rural women in Bangladesh had the lowest recorded BMI at 17.7 kg/m2 and rural men in Ethiopia had the lowest male BMI at 18.4 kg/m2, both recorded in 1985.
  • In 2017, both women and men in urban sub-Saharan Africa were heavier than their rural counterparts by a larger margin than anywhere else, particularly women in West African countries like Burkina Faso, Niger, Ghana and Togo.
  • Rural women in eastern and central Europe weighed more than their city counterparts by the greatest margin - about 1 kg/m2 or more in the Czech Republic, Latvia and Belarus that has largely stayed unchanged since 1985.
  • The biggest differences of rural over urban BMI were found in the Czech Republic, Sweden, Ireland, Australia, USA and Austria, all with rural BMI over 0.35 kg/m2 more than their city counterparts.


Rates of obesity are rising faster in rural compared to city areas in most countries of the world with the exception of Sub-Saharan Africa, and health experts have to explore newer ways to tackle this changing global trend of obesity and increased BMI.

Reference :
  1. Rising rural body-mass index is the main driver of the global obesity epidemic in adults - (http://dx.doi.org/10.1038/s41586-019-1171-x)

Source: Medindia

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